Treating TMJ disorders through chiropractic care

Observant careful rheumatologist looking for cause of pain

Temporomandibular Joint Dysfunction Syndrome (also known as TMD) is a condition that affects the temporomanidibular joint or TMJ, which is part of your jaw. The joint is the connection between the jaw and the temporal bones of the skull, located in the frontal portion of each ear. The joint is what enables you to move your jaw up and down and side to side, allowing you to perform motions such as talking or chewing.

What causes TMJ disorders?

The exact cause of TMD is undetermined. Many dentists believe its symptoms are the result of problems caused by jaw muscles or parts of the joint.

Sustaining injuries from hard impacts or whiplash can cause damage to the jaw or the surrounding muscles in the head and neck, leading to TMD. Other factors that can lead to the condition include:

  • Arthritis affecting the joint
  • Movement of the disc located between the joint’s ball and socket
  • Excessive clenching and grinding of teeth, which puts a lot of pressure on the joint
  • Tightening of facial and jaw muscles due to stress

Symptoms of TMD

People with TMD often experience severe pain and discomfort. This pain can sometimes be temporary, or it can last for several years, affecting one or both sides of the face.

According to some studies, TMD is more common in women than men, and it usually affects those between the ages of 20 to 40.

Common symptoms of TMD include the following:

  • Pain or discomfort whenever you open your mouth wide
  • Jaws locking in place, either when closing or opening the mouth
  • Problems experienced when chewing, as if the upper and lower part of the mouth are misaligned
  • Swelling on either side of the face
  • Popping or clicking sounds or sensations while opening or closing the mouth
  • Fatigue felt in the facial area
  • Pain or soreness in the face, jaw, neck, shoulders, or near the ear when talking, chewing, or opening the mouth

Some people with TMD also report having headaches, neck aches, toothaches, problems with hearing, and upper shoulder pain.

Chiropractic care for treating TMD

Chiropractic treatment can help those with TMD by alleviating pain through correcting misalignment problems between the spine and the nervous system.

Compared to other methods of treating TMD, chiropractic care can be a very effective alternative as it can help muscles relax, adjust joints properly, and accurately reposition the jaw, rather than relying on teeth modification or diet modification.

Successful chiropractic treatment for TMD will not only provide temporary pain relief, but can completely prevent the condition from reoccurring. Chiropractic treatment centered on the TMJ aims to relieve muscle tension in the areas surrounding the joints, both inside and outside of the mouth.

A chiropractor will be able to manipulate trigger points (which are made of muscle fibers), to alleviate pain caused by TMD. If the TMD is caused by misalignment of the neck and the upper back, a chiropractor can perform manipulations on the spinal joint affecting these areas. In addition to chiropractic care, massage therapy may be effective in relieving tight muscles in the back of the spine, which reduces amount of stress in the jaw.

Chiropractic care and medical insurance

Open enrollment healthcare benefit forms.

In the US, chiropractic treatment is recognized as a form of complementary and alternative medicine, or CAM. It is included in most major health insurance plans, as well as Medicare, several Medicaid plans, workers’ compensation, and Blue Cross Blue Shield insurance plans, to name a few.

For active-duty members of the armed forces, chiropractic care is offered in over 60 military bases throughout the country. Veterans can also get chiropractic treatment in more than 30 major veterans’ medical facilities.

What exactly do the insurance plans cover?

Specifics (such as amount covered, number of sessions allowed, referrals, etc.) vary with each individual health insurance plan.

For example, the Part B plan from Medicare covers basic chiropractic treatment, which includes spinal manipulation. However, the plan does not include coverage for the initial physical exam, x-ray analysis, orthopedic devices used, evaluation services, and physical therapy and/or vitamins and supplements recommended by the chiropractor.

Before arranging a visit with a chiropractor, it is recommended that you get in touch with your insurance provider, or simply read the fine print of your insurance plan to see what exactly it covers.

Is there any way to get my health insurance to cover chiropractic treatments?

Yes. The good news is, more and more health insurance providers are looking for new ways to achieve optimum health and wellness.

Here are some of the things you can do:

  • Know whether your insurance provider is an HMO (Healthcare Management Organization) or PPO (Preferred Provider Organization). HMOs typically include coverage of services from practitioners included on their approved list. PPOs, on the other hand, usually cover around 80% for chiropractic treatment from providers not on their approved list. If the healthcare provider is on their approved list, the PPO might have a prearranged fee with them.
  • Ask your chiropractor’s office if there are any alternatives in case your health insurance does not provide coverage for their treatments. Special financing plans are usually offered by many chiropractic practitioners.
  • Even if coverage for chiropractic care is not available, keep asking your health insurance provider, as doing so may get them to reconsider. If your doctor believes chiropractic treatment can help address your health issues, request a written letter which you can submit to your insurance provider.

A few helpful tips

  • During your initial visit, be sure to fill out your medical history form as completely and thoroughly as possible. Make sure you provide complete answers to any questions regarding prior injuries.
  • Even if your health insurance provider offers coverage, keep in mind that chiropractic treatments are usually moderately expensive. Contact your chiropractor and ask about the possible duration of your treatment, as well as the estimated price.
  • If your injury is due to a work-related or automobile accident, you may want to consider talking to your employer or automobile insurance company about the possibility of them providing coverage for chiropractic treatment.

For more information on medical insurance and other financing options, give us a call at 310-787-8104.

Gonstead chiropractic treatment for golf injuries

Gonstead chiropractic treatment for golf injuries

Golf is a sport that requires players to do a repetitive motion. Whether you practice on the driving range or play 18 holes on weekends, swinging a club again and again for years causes an amount of physical stress on the body, which negatively affects the supportive elements of the musculoskeletal system.

That said, it comes as no surprise that golf’s repetitive nature can often cause injuries to the neck, shoulder, ribs, and elbows. One body part that absorbs the most significant amount of stress however, is the back – more specifically, the lumbar spine, which absorbs most of the force. According to studies, approximately 80% of the 30 million golfers in the US have experienced some type of back pain or injury.

How it happens

Back pain or back injuries from playing golf does not happen immediately – it is the result of accumulated playing time. Over time, the repetitive swinging motion takes its toll on our bodies, weakening the structural integrity of the spine, shifting the vertebrae into an inefficient biomechanical position. Misaligned vertebrae can cause nerve and muscular pain, immobility, sciatic neuralgia, or compression or irritation of the sciatic nerve.

Why Gonstead chiropractic treatment is effective for golf-related injuries

Diagnosis and precise interpretation is the ideal solution when it comes to golf-related back or spinal injuries. The Gonstead system typically involves the following:

  • Weight-bearing x-rays that can accurately identify biomechanical alteration under load
  • MRI scan of the area
  • Processes that can accurately manipulate the vertebrae using precise 3D vectors
  • Post-treatment management and exercise stabilization

The Gonstead system has successfully treated countless US and European PGA pros, Ryder Cup players, and major champions.

For more information about the Gonstead system, take a look at this page.

Spinal adjustments before injuries occur

Chances of getting injured can be reduced significantly if your body is in optimum condition. By getting periodic spinal adjustments, you can effectively fine-tune your body, allowing it to function at maximum capacity. If the neck and back are properly aligned, repetitive motions (such as a golf swing) will have less negative impact on the body.

Chiropractic treatments can improve mobility

Even the most seasoned pros will tell you how important it is to have mobility in your golf game. Having a weak back or stiff joints will not only ruin your form, but it can also lead to injury over time.

Undergoing chiropractic treatment strengthens the body and keeps it loose, improving your golf game and reducing the chance of injury.

Faster healing through chiropractic care

  • Experienced chiropractors are able to adjust the spine and keep joints and surrounding tissue in top condition, minimizing pain and promoting healing.
  • Chiropractic treatments evaluate injuries by considering its potential effects on other parts of the body. By considering the body as a whole, injuries can heal quicker.
  • Golfers, whether they’re pros or amateurs, can greatly benefit from getting regular chiropractic treatments. Regular treatments will help maintain and strengthen your body, improving mobility and reducing chances of getting an injury.

Conditions treated by Gonstead chiropractic

Gonstead chiropractic

Here are several conditions that can effectively be treated through Gonstead chiropractic care:

Sciatica and lower back pain

According to studies, around 80% of people experience lower back pain at some point during their lifetime. In most cases, lower back pain is the cumulative effect of poor sitting posture, improper form when lifting, lack of exercise, and various lifestyle-related factors.

A combination of these factors causes stress and slight misalignments of the vertebrae (also known as subluxation), eventually resulting in back pain. Even simple movements such as bending down to retrieve something off the floor can lead to injury – when your spine is already compromised, even a seemingly harmless action can be enough to complicate minor problems. The pain we feel in our backs is due to the surrounding muscles that go into spasm in order to protect the damaged or stressed back tissues.

The Gonstead approach uses specific chiropractic adjustments that effectively restore the spinal bones’ normal position and range of motion. Its success is well-documented and has helped many patients avoid getting risky surgeries.

Whiplash

Whiplash injuries usually occur in falls or car accidents. This type of injury is caused by the head violently thrusting forwards and backwards, hyperextending and hyperflexing the cervical spine or neck.

The Gonstead approach assists recovery for whiplash injuries by adjusting the neck and spine in order for it to heal properly. Practitioners of the approach also recommend strengthening exercises, massage therapy, and nutritional advice to further enhance and assist recovery.

Osteoarthritis

Osteoarthritis happens when the cartilage of bones and joints degenerate due to processes that cause them to break down. It results in friction between the disc and the vertebrae, leading to strain and loss of motion in the spine’s gliding joints. When these joints are subjected to continued stress such as weakened muscles, exercise, and unavoidable factors like heredity and aging, severe pain can be experienced in the lower back and/or legs. Those suffering from osteoarthritis become more vulnerable to injury, as their spines have limited mobility and flexibility.

Through Gonstead chiropractic methods, the progression of osteoarthritis can be slowed down by using spinal adjustments, strengthening and stretching exercises, and massage therapy. The practice involves natural, drug-free ways that reduce pain and discomfort, improving the quality of life for those with the disease.

Disc problems

Disc problems are the result of normal wear and tear, injuries, and factors such as aging or genetics. Discs function as shock absorbers between the vertebrae composing the spinal column, and are constantly subjected to the pull of gravity and stress from movement during normal day-to-day activities.

Discs can be compromised by the alignment of the spine – misalignment can force a disc to protrude, herniate, or bulge, reaching the nerves and causing pain and discomfort.

The Gonstead approach is very effective in restoring the spine to its normal range of motion, reducing stress on the discs. The method uses massage therapy and exercises which strengthen the back and the abdominals, promoting stabilization of the core, an effective countermeasure for preventing disc problems.

How to prevent 5 common workout injuries

Workout injuries

Getting more exercise is good for the body, but getting too much (or doing something wrong) can sometimes result to severe pain or injury.

In this article, we’ll take a look at 5 of the most common workout injuries and what you can do to avoid them.

Rotator cuff injury

Rotator cuff injury

Your rotator cuff is responsible for stabilizing your shoulder. It is composed of four main muscles (the infraspinatus, subscapularis, supraspinatus, and teres minor). Shoulder pain when you extend your arms sideways, behind you, or overhead is a common symptom of rotator cuff injury.

How to prevent it: Good posture while working out is a good way to prevent rotator cuff injuries, as a slouched posture can compress your shoulder joint. Avoid repetitive overhead exercises or lat pulldowns behind the neck (do them from the front instead).

Biceps tendinitis

Biceps tendinitis

Biceps tendinitis is attributed to inflammation of a tendon that connects your upper biceps muscle to your shoulder bones. Common signs of biceps tendinitis are upper-arm weakness and pain from the front of your shoulder. Repetitive motions from activities such as swimming, golf, tennis, or weightlifting often cause this injury.

How to prevent it: Vary your exercise by cross-training, and avoid excessive overhead movements. Have sufficient rest between workouts, and maintain good posture.

Lower back strain

Lower back strain

Improper form when doing deadlifts or squats is a common cause for lower back strain. It can also be the result of bending sideways and other twisting motions. If you’re not careful, it can be worse, as doing such motions improperly can result to disk herniation or nerve compression.

How to prevent it: Maintain a neutral back, especially if you’re a beginner. Prepare for squats by doing the leg press or hip sled first to warm up. Better yet, consult a professional trainer about maintaining the proper form.

Stress fractures

Stress fractures

Stress fractures are injuries that often occur in your shins or the bones of your foot or heel. They typically result from excessive jumping in just one spot. Various sports such as basketball, gymnastics, tennis, or track and field increase the risk of getting this type of injury. Swelling or pain in an affected area while exercising, standing, or walking are two symptoms of having a stress fracture. If left untreated, it can lead to improper healing and chronic pain.

How to prevent it: When adapting a new exercise program, make sure you do it gradually to strengthen your muscles, decreasing stress on your bones. Adding variety by cross-training can be a big help as well.

Shin splints

Shin splints

Pain or muscle inflammation from along the inner edge of your tibia or shinbone can be a sign of shin splints. This injury is very common with runners, as well as athletes in sports involving plenty of running and jumping. Shin splints can be the result of a sudden increase in workout intensity, running uphill and downhill on hard surfaces, or running on uneven ground.

How to prevent it: When running, warm up by doing jumping jacks or jogging slowly for about five to ten minutes before gradually increasing your pace.

Why choose Gonstead chiropractic?

Established during the 1900s, the Gonstead System of Chiropractic is considered by many as the gold standard in hands-on spinal adjusting and one of the most effective chiropractic techniques available.

Its success is attributed to the lengthy training a Gonstead Doctor needs to complete. In addition to completing a five-year University Degree and Masters in Chiropractic Sciences required for all chiropractors, a Gonstead Doctor needs to intern for an additional year or more, and is required to attend several seminars each year.

About Dr. Clarence S. Gonstead

Dr. Clarence S. Gonstead

Dr. Clarence S. Gonstead (1898-1978) utilized his background in mechanical engineering and expertise of the nervous system in order to develop a unique, thorough approach to analyzing each segment of the spine.

During the 1930s, the chiropractic profession was dominated by BJ Palmer (1882-1961), who used a method called Hole-In-One (HIO), which is also known as Upper Cervical via Toggle Recoil application. At the time, technical skills of a typical graduating chiropractor were considered somewhat crude and rudimentary. It was Gonstead who introduced a logical and bio-mechanically sound approach to the practice.

With his skill in solving mechanical problems, Gonstead started developing his own ideas on x-rays, subluxations, and adjusting bones. He may not have been aware of it at the time, but what he started eventually redefined the very nature of the chiropractic profession.

In the early 1960s, the Gonstead technique was adopted by the Palmer School of Chiropractic, restoring the profession to its full-spine roots.

Reasons to choose a Gonstead chiropractor

  • The technique is thorough and specific. A Gonstead chiropractor will thoroughly assess and analyze your spine in order to determine the very cause of the problem. He or she will take the necessary steps to zero-in on which specific areas need to be adjusted, correcting subluxations using the most biomechanically advantageous methods that benefit the patient.
  • Gonstead chiropractors are able to adjust any joints in the body. A Gonstead chiropractor knows exactly how each joint functions in the body. Because they completely understand the mechanics of each joint, they are able to identify and correct subluxations in areas outside the spine – in shoulders, elbows, knees, ankles, and so on.
  • Gonstead chiropractors take their own x-rays. X-rays have a crucial role in determining the best ways to correct subluxations. Gonstead Doctors ensure that patients are positioned as precisely as possible so the x-rays that are taken will reveal the complete story.
  • Gonstead Doctors consider the body as a whole system. Practitioners of the Gonstead approach see how every part of the body responds to every adjustment. There are specific parts of the spine that can affect certain organs in our bodies, causing them to work faster or slower. Gonstead chiropractors take into consideration what to adjust and what not to adjust, in order to optimize your bodily functions. They also spend a lot of time outside of universities in order to gain better knowledge of how to correct subluxations in different parts of the body.

Causes and symptoms of lower back pain

Causes and symptoms of lower back pain

Lower back pain is something almost everyone has to deal with at some point during their lives. Those around the age of 30 are likely to experience lower back pain due to lower back muscle strain or pain from within the disc space, while older individuals typically experience it due to the degeneration of joints in the spine or compression fractures.

Lower back pain is caused by multiple problems from various parts of the interconnected network of nerves, bones, discs, spinal muscles, or tendons in our lumbar spine.

Common sources of lower back pain

Problems with any of the following parts or structures can result in lower back pain:

  • Irritated nerve roots that start from the lower back going to the legs
  • Irritated smaller nerves supplying the lower back
  • Strained lower back muscles
  • Damaged bones, joints, or ligaments
  • Degenerating intervertebral disc

Symptoms and severity of the pain varies from one individual to another. For example, a simple lower back muscle strain can be unbearable enough that an individual may need to go to the emergency room, while a degenerating disc can only cause some mild discomfort.

Taking note of the symptoms and getting a diagnosis that precisely identifies the underlying cause is key to getting effective pain relief.

Causes

Below are some of the common causes for lower back pain:

  • Muscle strain or sciatica – Experiencing back pain after lifting heavy objects or exercise is often caused by muscle strain. At times, this can also be attributed to a bulging or ruptured disc. If a damaged disc presses on the sciatic nerve, it results in pain that can be felt from the buttocks going down to one leg, also known as sciatica.
  • Twisting of the spine – If you often do activities that require movements such as lifting, pulling, or anything that twists your spine, you may experience lower back pain.
  • Working out – Excessive exercise or improper form during workouts can lead to overextended muscles, resulting in lower back pain.
  • Poor posture – Avoid slouching – your weight is best supported by your back when you maintain good posture. If you have a job that requires you to sit at a desk for almost the entire day, choose a chair with good lumbar support, keep your shoulders back, and feet even on the floor. Also stand up and walk around from time to time.
  • Carrying bags for extended periods – Your lower back supports your upper body, so carrying any additional weight can strain it, especially if it’s for long periods of time.
  • Chronic conditions – Some individuals experience lower back pain due to chronic conditions such as spinal stenosis, spondylitis, or fibromyalgia. These conditions affect the spinal cord, spinal joints and nerves, and lower back muscles.

Immediate treatment

Most individuals who experience lower back pain do not often require urgent care, but if the pain is the result of trauma, then it is best to seek medical help immediately.

Immediate treatment is also required if any of the following symptoms accompany the pain:

  • Unexplained weight loss
  • Significant leg weakness
  • Significant, continuous pain in the abdomen
  • Fever and chills
  • Sudden bowel and/or bladder incontinence

Gonstead vs. regular chiropractic

Gonstead vs. regular chiropractic

The Gonstead system was developed by Doctor Clarence S. Gonstead, the founder of the Gonstead Clinic of Chiropractic in Mount Horeb, Wisconsin. The system was the result of Dr. Gonstead’s 55 years of practice, which involved over four million chiropractic adjustments.

Today, the system is regarded as the most complete and effective methods of biomechanical analysis available for doctors of chiropractic.

Many wonder why the Gonstead system is not used by all chiropractors throughout the world. The reason is quite simple – the techniques require a very high level of mastery. In fact, one can look at the Gonstead system as an art form: every single adjustment requires a significant amount of skill, practice, and dedication.

The Gonstead concept of chiropractic

The Gonstead system focuses on the body’s structural foundation and intervertebral discs. A Gonstead chiropractor primarily considers spinal misalignments, nerve dysfunction, foundational imbalance, and motion disturbances as factors that affect a patient’s chiropractic health. Gonstead adjustments are typically designed to have maximum impact on the discs, helping restore the spine’s natural alignment and movement.

Gonstead chiropractors use in-depth methods to examine and analyze various factors that can effectively uncover characteristics of intervertebral disc lesions, full spine and pelvis alignment, neurological effects of vertebral subluxation and overall health.

Gonstead chiropractors use various examination procedures such as visualization of spinal posture, motion, and gait, static and dynamic palpation of bone structures and tissues, and instrumentation techniques such as para-spinal skin temperature assessment.

Gonstead chiropractors

Gonstead chiropractors use a more thorough method for spinal analysis, a system far more complex compared to what other chiropractors use.

A Gonstead chiropractor analyzes the spine using five criteria:

  • Visualization – Gonstead chiropractors use visualization in order to compare and cross reference other findings. They are adept at detecting subtle changes in posture and movement, searching for any nuances that could potentially indicate problems.
  • Static Palpation – A Gonstead chiropractor knows how to use the process of “feeling” your spine when you’re in a stationary position. They’re able to detect the presence of any swelling, tightness, tenderness, or unusual textures in the back’s tissues or muscles.
  • X-Ray Analysis – X-ray films are essential tools which help chiropractors visualize the patient’s entire spinal structure. By analyzing x-ray films, a Gonstead chiropractor is able to evaluate vertebral misalignments, posture, and integrity of the joints and discs. This helps them rule out any recent fractures or pathologies that may potentially be affecting the patient’s current condition. Full-spine radiographs are taken while a patient is in a standing, weight-bearing position in order to fully substantiate the results.
  • Instrumentation – A Gonstead chiropractor’s instrument of choice is the Nervoscope. This instrument is capable of detecting imbalanced distributions of heat along the spine, which could indicate nerve pressure or inflammation. The Nervoscope is simply guided down the length of a patient’s back during an examination.
  • Motion Palpation – Gonstead Chiropractors use the process of motion palpation by feeling a patient’s spine while he or she is in motion, or while they’re bending in different angles. This enables them to analyze each segment of the spine, detecting any difficulty as it moves and shifts in various directions.

Chiropractic and Physical Therapy

chiropractic-physical-therapy-torrance

Chiropractic and Physical Therapy in Torrance

New Health Medical has been providing chiropractic and physical therapy in Torrance for many years now.  Chiropractic and Physical Therapy (PT) are extremely effective treatments when used together. They are both natural treatments that seek to restore lost health and function without drugs or surgery.

New Health Medical, your Torrance Chiropractic Center understands that the combination of chiropractic and physical therapy can make the difference between success or failure in alleviating pain and discomfort.  Sometimes chiropractic is not enough, and sometimes PT is not enough.  Here at New Health Medical we have a fully equipped physical therapy department with highly trained therapists.  This enables us to provide optimal treatment for the most challenging injuries, which can greatly improve outcomes.

Torrance-physical-rehab

The combined physical therapy and chiropractic treatments are especially useful when it comes to sports injuries or auto accidents. Aligning the spine is great, but often there are injuries that require physical therapy and rehabilitation.  When you rehabilitate an injured body part properly you increase the odds of a long lasting permanent solution.   Chiropractic is great for maintenance care and so are physical therapy exercises.  Maintenance care will reduce the odds of re-injury and increase the odds of long term success.

To schedule an appointment for physical therapy and chiropractic in Torrance
please call (310) 787-8104.

sciatic-nerve-chiropractor

Are You Struggling With Sciatic Nerve Pain

A number of patients in the South Bay struggle with sciatica. We wanted to share some of the facts about sciatica so that it may help you understand your pain. The sciatic nerve is the largest and longest nerve in the human body, emerging from the spine in the lower back. It also runs through the buttock region, and all the way to the lower leg, where it functions to control the muscles in that region.

The sciatic nerve functions to provide sensation to the entire lower region of the body, including your thighs and legs and extending to the soles of your feet. If for any reason this nerve becomes irritated or inflamed, the pain that is caused is known as sciatica. Sciatica references the numerous symptoms that are directly associated with the irritation of the sciatic nerve, but does not indicate the source.

Sciatic Symptoms

The most common symptom of sciatic nerve irritation is when the pain flows consistently along the pathway of the nerve, especially when the pain is persistent on only one side of the body. There are considerable ways in which this pain can be experienced. Patients may experience a tingling sensation as well as aching or burning. The type of pain is often associated with the exact location of the irritation. It is possible that a patient suffering from sciatica will feel like they are being poked with pins and needles in their lower extremities, accompanied by weakness in the leg or foot of the affected nerve.

As a general rule, sciatica develops slowly and progressively, rarely beginning with intense pain. The pain is normally exacerbated by long sitting sessions, bending, sneezing or coughing as well as sudden movements.

Diagnosing Sciatica

The diagnosis of sciatica begins with your physician. Your physician will be able to take into consideration your medical history as well as evaluate your descriptions of the pain. It will also be necessary for you to undergo a complete neurological examination that will place an emphasis on your legs and spine. This includes the assessment of your sensory strength as you perform certain activities, allowing the doctor to assess your reflexes, muscle strength and any pain that may be caused by certain movements.

Treatment Options

In most cases, our Gonstead chiropractic care can be highly effective. Because sciatica can be caused by a number of issues, the treatments will vary based on the cause. This will depend heavily on your chiropractor. Our Gonstead method of chiropractic would be a conservative approach, meaning treatments are not invasive, requiring surgical procedures and medication.

A Gonstead chiropractic approach would be focused on eliminating or minimizing the pain by addressing any spinal issues, restoring normal movement and function, subsequently reducing the irritation and inflammation.

Should you have any questions concerning sciatica, please do not hesitate to call New Health Medical at (310) 787-8104